Minimally invasive approach for full thickness rectal prolapse is not associated with improved recurrence rates

Despite the multiplicity of surgical options for rectal prolapse, there is no clear superior repair. Given the rise of newer techniques and approaches we sought to evaluate the changing surgical choices over time and compare their recurrence rates.

Methods

We retrospectively identified 421 patients from a single institution who underwent repair for rectal prolapse over a 13-year period. Cases were classified based on surgical approach (abdominal – [laparoscopic vs. open] or perineal) and time of repair. Follow-up data were recorded from the electronic medical record or via telephone survey.

Results

For the entire cohort, 64.8% (n=273) of patients underwent a perineal approach. Of the abdominal approaches, 45.8% (n=67) were done with minimally invasive approaches, 55.4% (n=81) were open. There were 9.3% who were lost to follow-up and the recurrence free survival rate was 81.2% at four years (95%CI: 76.5 – 85.9). When divided into three time frames (early, mid and late) there were significantly more laparoscopic cases performed (when compared to open) in the late period compared to early (56% vs. 28%, respectively; p=0.006). There were an equal number of perineal cases performed in the early and late time periods (68% vs 62%, respectively; p = 0.30). The recurrence free survival rate between the early and late time periods did not reach statistical significance (2.2; 95%CI: 0.94 – 5.0).